Journal of Japanese Society for Emergency Medicine

Purpose: The purpose of this study is to compare the effective dose of whole-body CT for trauma between Japan and other countries.

Methods: This study was based on research for radiation exposure dose from whole-body CT for trauma in Japan that we reported in 2019. In this research, we corrected DLPs for CT examinations performed during 4-month period starting in August 2017. We converted DLP to effective doses using the conversion factors of effective dose per DLP.

Results: The median and maximum effective doses were 54.0 mSv, 8.4 mSv and 170.1 mSv, respectively. The effective dose exceeded 100 mSv in 48 cases (8％). We considered that these results were due to differences in scan protocols and scan phases of contrast enhancement CT.

Discussion: This study demonstrated that the effective radiation dose of whole-body CT for trauma in Japan is higher than that of other countries. Therefore, we considered that it is necessary to standardize the scan method for trauma whole-body CT in order to reduce radiation dose.

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A 4X-year-old man was referred to our emergency department with symptoms including fever, fatigue, shortness of breath, jaundice. Laboratory investigations demonstrated decreased levels of white blood cells and platelets while lactate dehydrogenase (LDH), C-reactive protein, triglyceride and ferritin exhibited significant elevations, which raised the suspicion of secondary Hemophagocytic lymphohistiocytosis (HLH). Despite immediate glucocorticoid pulse therapy and immunoglobulins along with antibiotic, his condition got worse. Therefore, we started continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter (PMMA-CHDF) on day 2. Subsequently, LDH and ferritin, which are considered as indirect cytokine markers, decreased and the patient’s condition has shown improvement. The day after admission, a bone marrow smear confirmed the diagnosis of HLH. The patient was discharged home with no further symptom. HLH is a severe and often lethal inflammatory syndrome characterized by macrophage activation and hypercytokinemia. Multidisciplinary treatment combined with early introduction of PMMA-CHDF for cytokine removal may control the disease course of HLH.

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We report the case of a patient without a prescription history who experienced cardiac arrest following the misuse of isosorbide dinitrate transdermal patches. A 93-year-old male with atrial fibrillation and chronic heart failure experienced chest discomfort and became immobile while seeking medical attention, which prompted an emergency call. Upon arrival, the emergency medical team found that the patient was in shock with no palpable radial pulse and a Japan Coma Scale score of 100. Shortly after being loaded into the ambulance, the patient experienced cardiac arrest with an initial rhythm of pulseless electrical activity. Cardiopulmonary resuscitation was initiated, and spontaneous circulation was restored. The patient was transferred to the hospital with continuous intravenous administration of lactated Ringer’s solution and assisted ventilation.

On examination at the hospital, an abrasion was noted on the left elbow, where two 40 mg isosorbide dinitrate transdermal patches were applied. This was suspected to be the cause of the cardiac arrest, and the patches were immediately removed by the medical team. The patient showed no further deterioration in vital signs and was discharged on the fifth day of hospitalization. The patient misused the isosorbide dinitrate transdermal patches, which he had believed to be adhesive bandages. There was no prescription history for this patient, and their misuse was suspected to be due to the transfer of medication from another individual.

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